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Compulsive Sexual Behavior Disorder, or Sex Addiction for the Lay Person

There seems to be a divide about sex addiction these days. Is it an addiction, is it an impulse control disorder, or is it just an excuse to act out. This is the debate going on right now, especially since the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) doesn’t currently list it, nor does the WHO’s International Classification of Diseases (ICD-10) which is the manual which is used the world over. Plus if this is science so shouldn’t there be more research on the topic if it actually is an issue? Not to mention what about an evidence-based practice approach to treatment? Where is that!?!?!?!? All of these are issues that are brought up when discussing this topic.

Well sex addiction, actually called compulsive sexual behavior disorder or CSBD for short, is a real issue for many. In fact it’s estimated that up to ~4% of the general population has CSBD and out of combat Veterans this figure jumps up to ~16%. It statistically effects more European/White males then any other group, but is seen in all groups to varying degrees. At present it isn’t known why Veterans who have seen war have a higher likelihood of developing CSBD. However, earlier this decade a study on brain lesion(s) in stroke survivors pointed out either an increase or a decrease in the sex drive on individuals depending on where the lesion(s) were. If they were on the left hemisphere the individuals saw a decrease in sex drive (hyposexuality) and if the lesion(s) were on the right hemisphere they as an increase in sex drive (hypersexuality). This is a possible correlation for Veterans who come home having experienced even one, but mostly numerous, blast waves from roadside bombs and controlled detonations, having possibly resulted in lesions forming on their brain.

It may be pointed out that currently neither of the two major manuals in the US actually list CSBD as a disorder. However, in 1987 with the release of the DSM-III the APA had sex addiction listed, but later removed it with the release of the DSM-IV, we are on the DSM-5 now. And the WHO has yet, to my knowledge, mentioned CSBD in any of their ten manuals, yet it is scheduled to be added to the ICD-11 which should be released within the next year. Once this happens the APA will then most likely add it to the next release of the DSM as they typically follow suit with the WHO. Despite it not being listed in current printings this shouldn’t be the final determinant as it takes many peer reviewed research articles before these governing bodies will add anything into their manuals. After all, with research into different topics happening all the time it causes conditions to change, be added, or be removed with each addition.

Speaking of research, there is plenty being financed and conducted. Believe it or not the Veterans Administration has one of the leading experts in CSBD working for them, Dr. Shane W. Kraus. He has given talks all over the world, conducted numerous published studies, and is even an adjunct professor for Yale. There are also Dr.’s Kafka and Potenza of Harvard and Yale, respectively, who both have conducted many studies themselves and are also experts in this area. No talk on the history of CSBD is complete without the mention of Dr. Carnes who created the Certified Sex Addiction Therapist (CSAT) certificate and has published many of the books used in treating the disorder. He helped spearhead the advancement of CSBD, calling it Sex Addiction, back in the 1980’s. One of the students from his course, Robert Weiss, has gone on to help continue the treatment of those struggling with CSBD and currently holds webinars and has a podcast on this subject for those struggling with CSBD as well as their loved ones and friends to better understand it.

Despite there being no evidence-based practice (EBP) approach to treating CSBD it is suggested a combination of CBT/DBT and a 12-Step program are the best methods of treatment. This has yet to be researched to verify or disprove this claim, though. At present it appears there is more research into what is sex addiction verses how to help those with it get it under control. It’s similar to a drug addiction or alcohol addiction with one caveat. You can put it down but you don’t stop having sex the rest of your life. The goal with therapy is to help control the impulse, the addiction, not on curing it as like with any other addiction you are never fully cured. It should also be noted that a majority of people with CSBD also report at least one other impulse control disorder or addiction, be that financial impulsivity, drug addiction, alcohol addiction, etc…

This has be a brief run down of sex addiction. Like it or not there is a growing body of evidence pointing to it being an impulse control disorder and moving from there to an addiction. Within the next decade it will no longer be debated as to if this is real or not, but instead the debate will be is it an impulse control disorder or an addiction.

Some names for sex addiction over the years include: nymphomania, satyrism, Don Juanism, and hypersexual disorder. Yet I, personally, argue that sex addiction and hypersexuality are in fact two separate things. You can be a sex addict with hypersexuality, but you don’t need to be a sex addict to be hypersexual. More on this discussion in a later post.

With love and respect,

Scott Lipic Moore MBA, MSW Candidate 2018